Adoption Application

If you are interested in adopting one of our available rescue animals please fill out this form.

Animal you are interested in adopting	Barbie (Dog - D2024001) CJ (Dog - D2020029) Haze (Dog - D2021010) Hunter (Dog - D2022015) Sammich (Dog - D2021018)
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Date of Birth *
Drivers License Number *
How did you find out about us?	Petfinder Internet Search Family/Friend Staff/Volunteer Facebook/Twitter Other
Do you own other pets at the current time? *	NoYes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed? *	Yes No N/A
Have you ever turned your dog or cat into a shelter? *	NoYes
If yes, please explain?
Have you ever had a pet euthanized? *	NoYes
If yes, please explain:
Do you own or rent your home? *	Own Rent Lives with Parents Military
Please select your current residence type. *	House Apartment Condo Townhouse Mobile Home Other
If you answered "other" above, please explain here:
How long have you lived at this address?	Less than one month 1-2 months 3-6 months 6-9 months 9-12 months 1-2 years 3-5 years 6-10 years 10 + years
If you rent, does your landlord and lease allow pets? *	Yes No Unsure N/A
Landlord Name if you rent please provide your landlords name.
Landlord Phone If you rent please provide a contact phone number for your landlord in case we need to contact them.
Including yourself, how many people live in your household? *
Please list the ages & relationship of those who live in your home. *
Is everyone in your household aware that you are planning to adopt a pet? *	Yes No N/A
Does anyone in your household have allergies to dogs/cats?	Yes No Possibly N/A
Employment Status	Full-Time Part-Time Retired Work from Home Stay at Home Parent Student Unemployed Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
On average, how many hours per day will your pet be left alone? *
Will this pet be predominantly living inside, outside, or both? *	Inside Outside Both
Please provide a description of this pet's living conditions.
Do you have a completely fenced-in yard? If so, what kind of fence? *	Block Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard)
Will you allow us to perform home checks? *	NoYes
I hereby certify that my responses to the questions are true and correct to the best of my knowledge. *	Yes No
I/We understand that The Churchill Foundation makes no guarantees or warranties regarding the health or temperament of this dog. I/We promise and agree to be solely responsible for this animal, and to indemnify and hold harmless The Churchill Foundation from any and all claims of liability for the conduct of this animal on or after the date of this adoption. This Release of Liability and Indemnification shall apply to all known, unknown and unanticipated damages resulting from my/our adoption, ownership or control of such animal. *	Yes No
I/We hereby agree to contact TCF immediately or return the animal should any problems or emergencies arise resulting in relinquishment of the TCF animal. TCF animals are not to be relinquished to any other shelter, home or rescue group without the approval of TCF official representative. *	Yes No
I/WE HEREBY ACKNOWLEDGE THAT I/WE HAVE READ AND UNDERSTAND THE ABOVE TERMS AND CONDITIONS AND WILL KEEP THE ANIMAL DESCRIBED HEREIN AS A FAMILY MEMBER. I/WE UNDERSTAND THAT THIS IS A BINDING CONTRACT ENFORCEABLE BY CIVIL LAW. *	Yes No